Healthcare Provider Details

I. General information

NPI: 1831396290
Provider Name (Legal Business Name): MARC JAMES MEYER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N MILDRED RD
CORTEZ CO
81321-2231
US

IV. Provider business mailing address

144 S MARKET ST
CORTEZ CO
81321-3504
US

V. Phone/Fax

Practice location:
  • Phone: 970-564-2190
  • Fax: 970-564-2197
Mailing address:
  • Phone: 970-565-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11912
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number11912
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11912
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: